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Abstract：
BACKGROUND: Data on pyogenic liver abscess (PLA) of children in China have been limited. We aimed to summarize the clinical feather, microbiological characteristics, management, and outcome of PLA in children.
METHODS: We retrospectively reviewed PLA cases from January 2008 to June 2023 at Beijing Children\'s Hospital. Clinical characteristics, pathogens and management were analyzed.
RESULTS: We diagnosed 57 PLA patients in our center. The median onset age was 4.5 years and the male-to-female ratio was 1.6:1. The median diagnostic time was nine days and the median length of stay was 22 days. Twenty-eight patients (49.1%) had predisposing factors, around 71.4% of the patients had malignant hematology and primary immunodeficiency disease. Patients with underlying factors were more likely to have extrahepatic organ involvement (p = 0.024), anemia (p < 0.001), single abscess (p = 0.042), unilateral involvement (p = 0.039), and small size of the abscess (p = 0.008). Twenty-four patients (42.1%) had extrahepatic organ involvement. Pathogens were identified in 17 patients (29.8%), the most common pathogens were Klebsiella pneumoniae and Staphylococcus aureus. The positive rate of metagenomic next-generation sequencing (mNGS) was 87.5% (7/8). On multivariable analysis, the extrahepatic organ involved (p = 0.029) and hepatomegaly (p = 0.025) were two independent factors associated with poor outcomes.
CONCLUSIONS: PLA is usually seen in children with predisposing factors. Malignant hematology and primary immunodeficiency disease were the most common underlying diseases. Extrahepatic organ involvement and hepatomegaly are associated with poor prognosis. Increased use of mNGS could be beneficial for identifying pathogens.
METHODS: We retrospectively reviewed PLA cases from January 2008 to June 2023 at Beijing Children\'s Hospital. Clinical characteristics, pathogens and management were analyzed.
RESULTS: We diagnosed 57 PLA patients in our center. The median onset age was 4.5 years and the male-to-female ratio was 1.6:1. The median diagnostic time was nine days and the median length of stay was 22 days. Twenty-eight patients (49.1%) had predisposing factors, around 71.4% of the patients had malignant hematology and primary immunodeficiency disease. Patients with underlying factors were more likely to have extrahepatic organ involvement (p = 0.024), anemia (p < 0.001), single abscess (p = 0.042), unilateral involvement (p = 0.039), and small size of the abscess (p = 0.008). Twenty-four patients (42.1%) had extrahepatic organ involvement. Pathogens were identified in 17 patients (29.8%), the most common pathogens were Klebsiella pneumoniae and Staphylococcus aureus. The positive rate of metagenomic next-generation sequencing (mNGS) was 87.5% (7/8). On multivariable analysis, the extrahepatic organ involved (p = 0.029) and hepatomegaly (p = 0.025) were two independent factors associated with poor outcomes.
CONCLUSIONS: PLA is usually seen in children with predisposing factors. Malignant hematology and primary immunodeficiency disease were the most common underlying diseases. Extrahepatic organ involvement and hepatomegaly are associated with poor prognosis. Increased use of mNGS could be beneficial for identifying pathogens.
摘要：
背景：中国儿童化脓性肝脓肿（PLA）的数据有限。我们旨在总结临床羽毛，微生物学特征，管理,和儿童解放军的结果。
方法：回顾性分析2008年1月至2023年6月北京儿童医院收治的解放军病例。临床特征,对病原菌及管理进行分析。
结果：我们在本中心诊断出57名解放军患者。中位发病年龄为4.5岁，男女比例为1.6：1。中位诊断时间为9天，中位住院时间为22天。28例患者（49.1%）有诱发因素，约71.4%的患者患有恶性血液病和原发性免疫缺陷病.有潜在因素的患者更可能有肝外器官受累（p=0.024），贫血（p<0.001），单个脓肿（p=0.042），单侧受累（p=0.039），脓肿小（p=0.008）。24例（42.1％）肝外器官受累。在17例患者中发现了病原体（29.8％），最常见的病原菌为肺炎克雷伯菌和金黄色葡萄球菌。宏基因组下一代测序(mNGS)阳性率为87.5%(7/8)。在多变量分析中，受累的肝外器官(p=0.029)和肝肿大(p=0.025)是与不良预后相关的两个独立因素.
结论：PLA通常见于有诱发因素的儿童。恶性血液病和原发性免疫缺陷疾病是最常见的基础疾病。肝外器官受累和肝肿大与不良预后相关。增加mNGS的使用可能有利于鉴定病原体。
方法：回顾性分析2008年1月至2023年6月北京儿童医院收治的解放军病例。临床特征,对病原菌及管理进行分析。
结果：我们在本中心诊断出57名解放军患者。中位发病年龄为4.5岁，男女比例为1.6：1。中位诊断时间为9天，中位住院时间为22天。28例患者（49.1%）有诱发因素，约71.4%的患者患有恶性血液病和原发性免疫缺陷病.有潜在因素的患者更可能有肝外器官受累（p=0.024），贫血（p<0.001），单个脓肿（p=0.042），单侧受累（p=0.039），脓肿小（p=0.008）。24例（42.1％）肝外器官受累。在17例患者中发现了病原体（29.8％），最常见的病原菌为肺炎克雷伯菌和金黄色葡萄球菌。宏基因组下一代测序(mNGS)阳性率为87.5%(7/8)。在多变量分析中，受累的肝外器官(p=0.029)和肝肿大(p=0.025)是与不良预后相关的两个独立因素.
结论：PLA通常见于有诱发因素的儿童。恶性血液病和原发性免疫缺陷疾病是最常见的基础疾病。肝外器官受累和肝肿大与不良预后相关。增加mNGS的使用可能有利于鉴定病原体。
